Renal artery stent placement for restoration of renal function in hemodialysis recipients with renal artery stenosis.
OBJECTIVE
Renal artery stent placement to treat renal artery stenosis (RAS) in patients undergoing hemodialysis is not performed commonly. We present our outcomes of discontinuation of hemodialysis after treating patients with RAS by stent placement on acute (< or =30 days of hemodialysis) and chronic hemodialysis (>30 days).


METHODS
A retrospective study was conducted in 16 patients (nine men) with an average age of 74.6 years +/- 10.6 (range, 49-86 y) who underwent treatment of 22 RAS for acute renal failure (n = 8) or uncontrolled hypertension with chronic hemodialysis (n = 8). The average follow-up was 448 days +/- 450 (median, 363.5 d; range, 6-1,583 d). The primary outcome consisted of discontinuation of hemodialysis, death, and transplantation. Secondary endpoints included restenosis, changes in blood pressure (and use of medications), and estimated glomerular filtration rate (eGFR).


RESULTS
After the stent procedure, eight patients were able to discontinue hemodialysis and remained free from dialysis over a mean period of 564 days +/- 533. The predictors of discontinuation of hemodialysis were 24-hour proteinuria, eGFR before renal artery stent placement, and size of the kidney on ultrasound studies (P < .05 for all three). There was no difference in patients who were undergoing acute versus chronic hemodialysis. There were three minor complications, and one patient died 6 days after the procedure because of multiple cardiovascular problems.


CONCLUSIONS
Renal artery stent placement for the treatment of RAS in patients receiving hemodialysis can result in discontinuation of hemodialysis in patients with low proteinuria level and adequate kidney size and eGFR.
Thatipelli
Mallik
M
Division of Cardiology, Department of Medicine, Mayo Clinic College of Medicine, 200 First Street Southwest, Alfred 6460, Rochester, MN 55902, USA.
Misra
Sanjay
S
Johnson
C Michael
CM
Andrews
James C
JC
Stanson
Anthony W
AW
Bjarnason
Haraldur
H
McKusick
Michael A
MA
D000368:Aged; D001807:Blood Vessel Prosthesis; D005260:Female; D006801:Humans; D008297:Male; D012078:Renal Artery Obstruction / Q000601:surgery*; D006435:Renal Dialysis; D051437:Renal Insufficiency / Q000534:rehabilitation* / Q000601:surgery*; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome